Prosthesis comprising a three-dimensional and openworked knit

ABSTRACT

The present invention relates to a prosthesis (100) comprising an openworked three-dimensional knit (101) comprising a front face and a rear face, each face being formed with one or more laps of yarns defining pores on said face, the front face being bound to the rear face by connecting yarns defining a spacer, characterized in that the connecting yarns are distributed so that they define an entanglement of yarns crossing each other at the spacer, without obstructing the pores of the front and rear faces.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No. 15/419,860 filed Jan. 30, 2017, which is a continuation of U.S. patent application Ser. No. 14/003,529 filed Sep. 6, 2013, now issued U.S. Pat. No. 9,554,887, which is a National Stage Application of PCT/EP12/54709, filed Mar. 16, 2012, under 35 U.S.C. 371(a), which claims benefit of and priority to French Patent Application Serial No. 11/52167 filed Mar. 16, 2011, the disclosures of each of the above-identified applications are hereby incorporated by reference in their entirety.

The invention relates to a prosthesis comprising an openworked three-dimensional knit, for example useful as a wall reinforcement in parietal and/or visceral surgery.

By three-dimensional knit, in the sense of the present application, is meant a knit having a front face and a rear face, each face being formed with one or more laps of yarns, the front face being bound to the rear face through connecting yarns defining a spacer. The presence of the spacer thereby provides some thickness to the knit: such three-dimensional knits may be obtained with a knitting machine of the warp type or two-bed Rachel type.

By openworked knit, in the sense of the present application, is meant the feature according to which the knit has pores, or further open voids, cells, holes or orifices, either regularly distributed or not, promoting cell colonization. The pores may appear in any kinds of shapes such as for example, spheres, channels, hexagonal shapes.

The spacer as defined above may be formed either with certain yarns of the lap(s) of one of the two faces, which regularly leave their original face for producing a stitch on the other face, and then return to their original lap, or on the contrary with one or more laps of yarns which are dedicated to the spacer and which run to and fro from one face to the other of the knit without being significantly involved in producing each face.

Openworked three-dimensional knits with a spacer connecting the front face to the rear face of the knit are already known. Thus document WO99/05990 describes openworked three-dimensional knits, the spacer of which is produced by one or more laps of connecting yarns dedicated to the formation of said spacer. As indicated in this document, the connecting yarns extend perpendicularly from one face towards the other and form transverse channels parallel with each other.

When they are subject to a compressive force, tending to press the front face of the knit onto its rear face, or tensile force, the knits as described in WO99/05990 may see the spacer «be laid down» or “fall” under this stress, so as to reach a position almost parallel to each of both faces: such a phenomenon causes sliding of the front face relatively to the rear face, this may cause a shift of the pores of the front face relatively to the pores of the rear face. The knit undergoes a «flattening» phenomenon and the walls of the pores of one face may move and obstruct the pores of the other face. The knit then loses its capability of promoting cell recolonization. Moreover, it is no longer possible to see in transparence through the knit, which may be a difficulty for the surgeon upon setting into place a reinforcement prosthesis for example made from such a knit.

Thus, it would be desirable to have a prosthesis comprising an openworked three-dimensional knit, having a spacer capable of withstanding compression and tension, in particular with view to avoiding deformation, and in particular with a view to avoiding collapse, of the knit when the latter is subject to such stresses. It would also be desirable to provide such an improved prosthesis without having to add too much of material forming the knit, in a view to limit foreign material intended to be implanted in the body of a patient.

The object of the present invention is to provide a prosthesis comprising an openworked three-dimensional knit retaining its three-dimensional structure even when it is subject to compressive forces, for example from one face onto the other, or to tensile forces.

The present invention relates to a prosthesis comprising at least one openworked three-dimensional knit comprising two opposite faces, for example a front face and a rear face, each face being formed with one or more laps of yarns defining pores on said face, one face being bound to the opposite face by connecting yarns defining a spacer, characterized in that the connecting yarns are distributed so that they define an entanglement of yarns which cross each other at the spacer, without obstructing the pores of the two opposite faces.

Thus, unlike the knits of the prior art, the connecting yarns of the knit of the prosthesis according to the invention do not form parallel channels with each other and perpendicular to the faces of the knit. On the contrary, in the knit of the prosthesis according to the invention, the yarns of the spacer run from one face to the other of the knit obliquely and not in parallel, i.e. these yarns cross each other, giving the spacer an «X profile» («X-stitch») or «crossed profile». In the knit of the prosthesis according to the invention, at least part of the connecting yarns forming the spacer cross each other, giving the knit significant stability of its three-dimensional structure, even when the knit is subject to compressive forces, tending to press its front face onto its rear face. Thus, in the knit of the prosthesis according to the invention, the spacer does not tend to place itself in a position parallel to both faces of the knit when the knit is subject to compressive forces, and the front face does not slide relatively to the rear face. With the knit of the prosthesis according to the invention, the front face remains facing the rear face, without any shift, when the knit is subject to compressive forces. Thus, the pores of the front face and the pores of the rear face, which for example are facing each other when the knit is at rest, remain in the same relative position even when the knit is subject to compressive forces. The transparence of the knit of the prosthesis according to the invention may thereby be maintained in both situations.

Further, the knit of the prosthesis according to the invention retains a good capability for cell recolonization, even under compression or under tension, the pores of the front face not being obstructed by yarns forming the walls of the pores of the rear face. The knit of the prosthesis according to the invention retains its three-dimensional structure even under compression or under tension.

Resistance to suture of the knit of the prosthesis according to the invention is also excellent.

In one embodiment, one face being formed with r rows and n columns of stitches, located facing r′ rows and n′ columns of stitches forming the opposite face, with at least one portion of the connecting yarns, at either regular row number intervals or not, connects a column n_(i) of one of the two faces to the column (n_(i)′+x), wherein x ranges from 2 to 5, of the opposite face, and, at either regular row number intervals or not, connects a column n_(j) of one of the two faces to the column (n_(j)′−x′) of the opposite face, wherein x′ ranges from 2 to 5.

In one embodiment, the row number intervals are regular. An optimum entanglement of connecting yarns crossing each other is thereby obtained.

In one embodiment, x=x′, for example, x=x′=2. This means that either regularly or not, each connecting yarn connects a column n_(i) of one of the two faces, not to the column n_(i)′ located facing the column n_(i) on the opposite face, but to the column (n_(i)′+2) of the opposite face, i.e. to a column of the opposite face shifted by two columns in a first direction with respect to the column n_(i)′ of the opposite face. Thus, the connecting yarn is not perpendicular to the faces of the knit but is oblique relatively to these faces. Further, either regularly or not, this yarn also connects a column n_(j), which may for example be the column (n_(i)′+2) above or not, of one of the two faces to another column (n_(j)′−2) of the opposite face, i.e. shifted by two columns in the direction opposite to the first direction. Thus, on the whole of the knit of the prosthesis according to the invention, connecting yarns regularly cross each other at the spacer. The three-dimensional stability of the spacer, and therefore of the knit, is reinforced.

In another embodiment, x=x′=3. In such a case, each connecting yarn runs back on the opposite face to a column shifted by three columns relatively to its original column of the starting face, in one direction and then in the other. In still another embodiment, x=x′=4. In such a case, each connecting yarn runs back onto the opposite face, to a column shifted by four columns relatively to its original column of the starting face, in one direction and then in the other.

In another embodiment, x is different from x′. For example, the connecting yarn is shifted by 2 columns when it connects one of the two faces to the opposite face in a lateral direction of the knit and is then shifted by 3 columns when it again connects one of the two faces to the opposite face, in the opposite lateral direction.

In one embodiment of the invention, the connecting yarns are yarns from at least one lap among the laps forming both opposite faces. In such an embodiment, the knit of the prosthesis according to the invention preferably does not comprise any additional yarn laps for producing the spacer. Thus, this is, for example, one or more of the lap(s) making up the front face which include(s) at regular intervals, stitches caught with the stitches of one or more of the lap(s) of the rear face, in order to ensure the connection between both faces. With such embodiments it is possible to limit the amount of yarns present in the knit of the prosthesis according to the invention, while obtaining a spacer having a good resistance to compressive forces. Thus, the pores of the front face and the pores of the rear face remain in the same relative position even when the knit is subject to compressive forces. The transparence of the knit is maintained even when the knit is subject to compressive forces. In addition, embodiments where the connecting yarns are yarns from at least one lap among the laps forming both opposite faces allow obtaining an optimal combination between on one hand the three-dimensional porous structure of the knit, for a good cell colonization, and on the other hand the thickness of the knit, which must not be too great in order to facilitate the introduction of the knit in a trocar in case the prosthesis is implanted via a trocar.

In another embodiment, the connecting yarns are yarns from one or more laps dedicated to the formation of the spacer. With such embodiments it is possible to use different yarns for forming the spacer with respect to the yarns used for forming the front face and/or the rear face, and to thus impart different properties, for example resorption properties to the spacer.

Both opposite faces, for example the front face and the rear face and the spacer of the knit of the prosthesis according to the invention may be made in any biocompatible, monofilament and/or multi-filament yarn either bioresorbable or not, customarily used in the making of prosthetic knits.

In embodiments, the connecting yarns define in addition a set of parallel or oblique yarns not crossing each other and not obstructing the pores of the two opposite faces. This set of parallel or oblique yarns not crossing each other and not obstructing the pores of the two opposite faces form additional connections between the front and the rear face which, in particular when such connecting yarns are yarns from one lap from the laps forming both opposite faces, bring additional resistance to compressive force to the knitted structure. In particular, the stability of the three-dimensional structure of the knit is increased, and the knit thus obtained shows a three-dimensional structure particularly capable of resisting to flattening and collapsing when a compressive force is applied onto the knit.

The present invention further relates to a prosthesis comprising at least one openworked three-dimensional knit comprising two opposite faces, for example a front face and a rear face, each face being formed with one or more laps of yarns defining pores on said face, one face being bound to the opposite face by connecting yarns defining a spacer, the connecting yarns being distributed so that they define an entanglement of yarns crossing each other at the spacer, without obstructing the pores of the two opposite faces, said knit being obtainable by knitting on a knitting machine of the warp or Rachel type comprising two opposite beds, each respectively with m and m′ needles, the needles m of one bed facing the needles m′ of the opposite bed, the connecting yarns being distributed over at least one guide bar BE1, said bar BE1 having at least one lateral movement in one direction from one needle m_(i) of one of the two beds to a needle (m_(i)′+x) of the opposite bed, wherein x ranges from 2 to 5, and a lateral movement in the opposite direction from one needle m_(j) of one of the two beds to a needle (m_(j)′−x′) of the opposite bed, wherein x′ ranges from 2 to 5.

Thus, during the knitting of the knit, a connecting yarn leaves a needle m_(i) of one face in order to connect either regularly or not, not the needle m_(i)′ of the opposite face, but a needle shifted by 2, 3, 4 or 5 needles in a first direction with respect to the needle m_(i)′. Also, either regularly or not, the connecting yarn connects a needle m_(j) of one face to a needle of the opposite face, shifted by 2, 3, 4 or 5 needles in the direction opposite to the first direction relatively to the needle m_(j)′.

In an embodiment of the prosthesis according to the invention, the knit is formed by knitting threaded yarns, one full stitch, one empty stitch, on four guide bars BAV, BE1, BAR1 and BAR2, the bars BAV and BE1 forming two laps of yarns producing the front face, the bars BAR1 and BAR2 forming two laps of yarns producing the rear face and the bar BE1 forming the spacer. In such embodiments, it is the yarns of the front face which achieve the connection between both faces and which therefore form the spacer. Thus, the bar BE1 is involved in both the formation of a lap of the front face and in the formation of the spacer.

In an embodiment of the prosthesis according to the invention, the knit is formed by knitting threaded yarns, one full stitch, one empty stitch, on four guide bars BAV, BE1, BAR1 and BAR2, the bars BAV and BE1 forming two laps of yarns producing the front face, the bars BAR1 and BAR2 forming two laps of yarns producing the rear face and the bar BE1 forming the spacer, said laps being knitted according to the scheme below according to the ISO 11676 standard:

BAV:4.3.2.2/1.0.1.1/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1/1.2.3.3/4.5.4.4/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4//

BE1:1.2.3.3/4.5.1.2/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4/4.3.2.2/1.0.4.3/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1//

BAR1:4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0/1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5//

BAR2:1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5/4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0//

In such a method, yarns of the front face are essentially the ones which achieve the connection between both faces and therefore the spacer. Thus, the bar BE1 is involved in both the formation of a lap of the front face and in the formation of the spacer.

Alternatively, the knit is formed by knitting threaded yarns, one full stitch, one empty stitch, on four guide bars BAV, BE1, BAR1 and BAR2, the bars BAV and BE1 forming two laps of yarns producing the front face, the bars BAR1 and BAR2 forming two laps of yarns producing the rear face and the bar BE1 forming the spacer, said laps being knitted according to the scheme below according to the ISO 11676 standard:

BAV:4.3.2.2/1.0.1.1/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1/1.2.3.3/4.5.4.4/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4//

BE1:1.2.3.3/4.5.2.1/4.3.4.5/4.5.4.4/4.3.4.5/4.5.4.4/4.3.2.2/1.0.3.4/1.2.1.0/1.0.1.1/1.2.1.0/1.0.1.1//

BAR1:4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0/1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5//

BAR2:1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5/4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0//

In such a method, the bar BE1 is still involved in both the formation of a lap of the front face and in the formation of the spacer, but its scheme has been modified so that the connecting yarns define in addition a set of parallel or oblique yarns not crossing each other and not obstructing the pores of the two opposite faces. Such an embodiment brings additional connections between the front and the rear faces: such additional connections between the front and the rear face, with connecting yarns which are yarns from a lap of the front face, bring additional resistance to compressive force to the knitted structure, as well as an optimum thickness to the three-dimensional structure of the knit.

In another embodiment of the prosthesis according to the invention, the knit is formed by knitting threaded yarns 1 full stitch, 1 empty stitch, on six guide bars BAV1, BAV2, BE1, BE2, BAR1 and BAR2, the bars BAV1 and BAV2 forming two laps of yarns forming the front face, the bars BAR1 and BAR2 forming two laps of yarns producing the rear face and the bars BE1 and BE2 forming the spacer, said laps being knitted according to the scheme below according to the ISO 11676 standard:

BAV1: 1.0.1.1/1.2.1.1/1.0.1.1/2.3.2.2/2.1.2.2/2.3.3.3/4.5.4.4/4.3.4.4/4.5.4.4/3.2.3.3/3.4.3.3/3.2.2.2//

BAV2: 4.5.4.4/4.3.4.4/4.5.4.4/3.2.3.3/3.4.3.3/3.2.2.2/1.0.1.1/1.2.1.1/1.0.1.1/2.3.2.2/2.1.2.2/2.3.3.3//

BE1: 1.1.1.0/1.0.1.0/1.0.1.1/1.1.1.0/2.3.2.3/2.3.2.2/2.2.2.3/2.3.2.3/2.3.2.2/2.2.2.3/1.0.1.0/1.0.1.1//

BE2: 2.2.2.3/2.3.2.3/2.3.2.2/2.2.2.3/1.0.1.0/1.0.1.1/1.1.1.0/1.0.1.0/1.0.1.1/1.1.1.0/2.3.2.3/2.3.2.2//

BAR1: 2.2.1.0/1.1.1.2/1.1.1.0/1.1.2.3/2.2.2.1/2.2.2.3/3.3.4.5/4.4.4.3/4.4.4.5/4.4.3.2/3.3.3.4/3.3.3.2//

BAR2: 3.3.4.5/4.4.4.3/4.4.4.5/4.4.3.2/3.3.3.4/3.3.3.2/2.2.1.0/1.1.1.2/1.1.1.0/1.1.2.3/2.2.2.1/2.2.2.3//

In such a method, the spacer is formed by means of two bars BE1 and BE2, the yarns of which are dedicated to the formation of the spacer.

In an embodiment, at least one of the faces of the knit of the prosthesis according to the invention is covered with an anti-adhesion coating, in particular in order to avoid the formation of undesired post-surgical severe fibrous adhesions.

By «anti-adhesion» in the sense of the present application, is meant a smooth and non-porous biocompatible material or coating which does not provide any space for cell recolonization and avoiding that surrounding organs adhere onto the prosthesis.

The anti-adhesion material or coating may be selected from bioresorbable materials, non-bioresorbable materials and mixtures thereof.

Non-bioresorbable anti-adhesion materials may be selected from polytetrafluoroethylene, polysiloxanes, polyurethanes, stainless steels, derivatives of precious metals and their mixtures.

Preferentially, said anti-adhesion material or coating is bioresorbable: bioresorbable materials suitable for said anti-adhesion coating may be selected from collagens, for example oxidized collagen, oxidized celluloses, polyacrylates, trimethylene carbonates, caprolactones, dioxanones, glycolic acid, lactic acid, glycolides, lactides, polysaccharides for example chitosans, polyglucuronic acids, hyaluronic acids, dextrans, fucans, polyethylene glycols, glycerol and mixtures thereof.

In an embodiment of the invention, the material forming the anti-adhesion coating is a hydrophilic bioresorbable material, preferably selected from the group formed by collagens, polysaccharides and mixtures thereof. Among the collagens which may be used according to the invention, mention may be made of:

1) collagen, the helical structure of which is at least partly thermo-denaturated, without any hydrolytic degradation, the preparation method of which is described in WO99/06080 the contents of which is incorporated to the present application by reference,

2) native, non-heated, film collagen with or without glycerin, crosslinked by gamma irradiation or by any other chemical or physical means,

3) and/or mixtures thereof.

Among the polysaccharides which may used as a resorbable hydrophilic material according to the invention, mention may be made of oxidized cellulose, hyaluronic acid, starch, chitosan, crosslinked dextrans and/or mixtures thereof. All these materials are well known to one skilled in the art. As an oxidized cellulose suitable for the present invention, mention may be made of the product sold under the trade name of «Interceed®» by Ethicon. As hyaluronic acid suitable for the present invention, mention may be made of the product sold under the trade name of «Hyalobarrier®» by Fidia Advanced Biopolymers, or of the product sold under the trade name of «Seprafilm®» by Genzyme.

During the implantation of the prosthesis according to the invention, for example as a wall reinforcement during the treatment of a hernia, the anti-adhesion coating provides protection at least during the initial healing phase to the knit of the prosthesis at the location where this adherent coating is present, i.e. the covered face(s) of the knit is(are) not exposed to inflammatory cells such as granulocytes, monocytes, macrophages or further giant multi-nucleated cells generally activated by the surgical gesture. Indeed, at least during the initial healing phase, the duration of which may vary from about 5 to 10 days, only the anti-adhesion coating is accessible by the different factors such as proteins, enzymes, cytokines or cells of the inflammatory line.

In the case when the anti-adhesion coating consists of non-resorbable materials, it thus protects the knit before and after implantation, over the whole period of implantation of the prosthesis.

Moreover, by means of the anti-adhesion coating, the surrounding fragile tissues such as hollow viscera are for example in particular protected from the formation of undesired post-surgical severe fibrous adhesions.

In the case when the anti-adhesion material comprises a bioresorbable material, it is preferable to select a bioresorbable material which is not resorbed before several days so that the anti-adhesion coating may ensure its function of protecting the surrounding organs during the days following the operation, and, until cell rehabilitation of the prosthesis protects these organs in turn.

In an embodiment, the anti-adhesion coating is in the form of a bioresorbable textile. For example, the bioresorbable textile comprises oxidized cellulose. Such a textile is for example described in US2007/0032805, the contents of which is incorporated into the present application by reference.

In an embodiment, the anti-adhesion coating is in the form of a bioresorbable film.

In an embodiment, the anti-adhesion coating is a film of a mixture of collagen and glycerol: the preparation of such a film is described in U.S. Pat. Nos. 6,451,032, 6,165,488 and 6,391,939, the contents of which are incorporated into the present application by reference.

In an embodiment, the anti-adhesion coating is a film of a mixture of collagen and chitosan. The preparation of such a film is for example described in document US2010/0016872, the contents of which is incorporated into the present application by reference.

In an embodiment, the anti-adhesion coating is a film of a mixture of collagen and of fucan as described in document US-2009-0005867, the contents of which is incorporated into the present application by reference.

In an embodiment, the anti-adhesion coating is a film of a polysaccharide derivative as described in U.S. Pat. No. 6,264,702, the contents of which is incorporated into the present application by reference.

In an embodiment, the anti-adhesion coating is a film of cellulose as described in document WO2010/052585, the contents of which is incorporated into the present application by reference.

In an embodiment, the prosthesis according to the invention further comprises at least one textile layer in addition to said openworked three-dimensional knit, said textile layer being attached to one face of said knit. The textile layer may be any mesh, woven fabric, knit, non-woven fabric, made in a biocompatible material, in particular by means of biocompatible yarns, such as for example multifilament yarns, monofilament yarns and combinations thereof. Preferably, the textile is openworked. The textile may be a knit either identical or different from said openworked three-dimensional knit; it may thus be made according to the same weaves or not, with the same yarns or with different yarns.

Said textile layer may have the same shape as the shape of the openworked three-dimensional knit or a different shape. The textile layer may be attached to one face of the openworked three-dimensional knit in a continuous way or in a discrete way, by any attachment means, such as for example by sewing, by adhesive, by welding or by a combination of these means.

In an embodiment, as the openworked three-dimensional knit is in the form of a continuous part having a periphery, the textile layer has a shape with a periphery substantially identical with that of said part, said knit and said textile layer being attached to each other at their respective periphery, said textile layer being provided with a central aperture.

Preferably, when the prosthesis comprises an anti-adhesion coating as described above and a textile layer as described above, the anti-adhesion coating is present on the face of the knit opposite to the face where the textile layer is attached.

In such an embodiment, the textile layer, because of the presence of its central aperture, forms a kind of skirt which may effectively be used by the surgeon upon implanting the prosthesis, as an attachment means, by suturing this skirt to the abdominal wall.

The invention will be better understood from the detailed description and the examples which follow, as well as with the figures wherein:

FIG. 1 is a view of the weave of a knit of a prosthesis according to the invention,

FIG. 2 is a view of the weave of a knit of another embodiment of a prosthesis according to the invention,

FIG. 3 is a scanning electron microscope view of one face of the knit obtained with the weave of FIG. 1 ,

FIG. 4 is a top view of an embodiment of a prosthesis according to the invention,

FIG. 5 is a top view of another embodiment of a prosthesis according to the invention,

FIG. 6 is a view of the weave of a knit of another embodiment of a prosthesis according to the invention,

FIG. 7 is a scanning electron microscope view of one face of the knit obtained with the weave of FIG. 6 .

With reference to FIG. 4 , a prosthesis 100 according to the invention is illustrated, comprising an openworked three-dimensional knit 101 comprising a front face 102 and a rear face (not visible in the figure): this knit 101 may be produced according to Example 1 below or according to Example 2 or according to Example 3 below. Thus, each face of the knit 101 is formed with one or more laps of yarns defining pores on said face, a face being bound to the opposite face by connecting yarns defining a spacer, the connecting yarns are distributed so that they define an entanglement of yarns which cross each other at the spacer, without obstructing the pores of the two opposite faces.

In the illustrated example, the knit 101 is in the form of a round part and has a circular periphery 101 a. The prosthesis 100 further comprises a textile layer 103, having a periphery 103 a substantially identical with that of the knit 101. The textile layer 103 is attached through its periphery 103 a to the periphery 101 a of the knit 101, and it has a central aperture 104: the textile layer 103 thereby forms a free skirt 105. During the implantation of the prosthesis 100 at a defect of the abdominal wall, for example in the treatment of a hernia, the surgeon may suture this free skirt 105 to the abdominal wall in order to effectively attach the prosthesis 100.

The prosthesis 100 further comprises an anti-adhesion coating in the form of a film 106 covering the rear face of the knit 101. In the illustrated example, the film 106 slightly juts out from the peripheries (101 a, 103 a) of the knit 101 and of the textile layer 103. Preferably, the film is obtained from a mixture of oxidized collagen and glycerol as described in U.S. Pat. Nos. 6,451,032, 6,165,488 and 6,391,939.

Such a film 106 prevents the formation of post-surgical fibrous adhesions.

By the properties of the three-dimensional knit as mentioned in Examples 1, 2 and 3 below, the prosthesis according to the invention as described in FIG. 4 has excellent three-dimensional stability and therefore a good capability for cell recolonization, even when the prosthesis is subject to pressure forces tending to press both faces against each other, as this may be accomplished by abdominal pressure. The prosthesis according to the invention also has excellent resistance to suture.

In FIG. 5 , for which the references designating the same elements as for FIG. 4 have been retained, is illustrated a prosthesis 100 similar to the one of FIG. 4 , but the openworked three-dimensional knit 101 has the shape of a globally rectangular part.

The present application also describes a method for treating hernia consisting of providing a prosthesis according to the invention and of implanting it at the hernial defect: for example the face of the knit covered with the anti-adhesion coating is placed facing the abdominal cavity while the non-covered face, either provided or not with an additional textile layer forming a skirt, is placed facing the abdominal wall, with view to cell recolonization. When the prosthesis comprises a skirt as described above, the surgeon may directly attach the skirt of the prosthesis to the abdominal wall by means of sutures or clamps.

EXAMPLE 1

A knit suitable for the prosthesis according to the invention is produced with 50 decitex multi-filament polyester yarns, number of filaments per yarn: 22.

The knit is produced on a two-bed Rachel knitting machine with 6 threaded guide bars 1 full stitch, 1 empty stitch, according to the following weave according to the ISO 11676 standard:

BAV1: 1.0.1.1/1.2.1.1/1.0.1.1/2.3.2.2/2.1.2.2/2.3.3.3/4.5.4.4/4.3.4.4/4.5.4.4/3.2.3.3/3.4.3.3/3.2.2.2//

BAV2: 4.5.4.4/4.3.4.4/4.5.4.4/3.2.3.3/3.4.3.3/3.2.2.2/1.0.1.1/1.2.1.1/1.0.1.1/2.3.2.2/2.1.2.2/2.3.3.3//

BE1: 1.1.1.0/1.0.1.0/1.0.1.1/1.1.1.0/2.3.2.3/2.3.2.2/2.2.2.3/2.3.2.3/2.3.2.2/2.2.2.3/1.0.1.0/1.0.1.1//

BE2: 2.2.2.3/2.3.2.3/2.3.2.2/2.2.2.3/1.0.1.0/1.0.1.1/1.1.1.0/1.0.1.0/1.0.1.1/1.1.1.0/2.3.2.3/2.3.2.2//

BAR1: 2.2.1.0/1.1.1.2/1.1.1.0/1.1.2.3/2.2.2.1/2.2.2.3/3.3.4.5/4.4.4.3/4.4.4.5/4.4.3.2/3.3.3.4/3.3.3.2//

BAR2: 3.3.4.5/4.4.4.3/4.4.4.5/4.4.3.2/3.3.3.4/3.3.3.2/2.2.1.0/1.1.1.2/1.1.1.0/1.1.2.3/2.2.2.1/2.2.2.3//

This weave is illustrated in FIG. 1 , in which the bars BAV1, BAV2, BE1, BE2, BAR1 and BAR2, are indicated with for each bar the path of a yarn (indicated in solid lines). In this figure, the numbers 1, 2, 3, . . . 12 indicate the rows of stitches of the front face; the numbers 1′, 2′, 3′, . . . , 12′ indicate the rows of stitches of the rear face. Also in this figure, a vertical sequence of points represents two columns of stitches, both front and rear, facing each other. In FIG. 1 , the columns are indicated as n, n′, (n+1), (n′+1), (n+2) and (n′+2).

In the present example the yarns of the BAV1 and BAV2 bars form the front face, the yarns of the BE1 and BE2 bars form the spacer and the yarns of the BAR1 and BAR2 bars form the rear face. In the present example, the connecting yarns are therefore yarns from laps dedicated to the formation of the spacer, i.e. the laps obtained with the BE1 and BE2 bars.

The weave followed for the front face produces a front face comprising pores. Also, the weave followed for the rear face produces a face comprising pores. The pores of the front face are substantially facing the pores of the rear face.

As this appears in FIG. 1 , the yarn of the BE1 bar, at the row 4′ and at the column n′ of the rear face, does not connect column n of the 5^(th) row of the front face, but it connects column (n+2). By doing this, it connects the rear face to the front face obliquely and not perpendicularly to these faces. Next, this yarn at the row 10′ of the rear face, connects column (n′+2) to column n at the 11^(th) row of the front face. In the present example, x and x′ as defined in the present application are therefore each equal to 2.

The yarn of the BE2 bar is also involved in the formation of the spacer, symmetrically to the yarn of the BE1 bar.

Thus, the spacer obtained is formed with connecting yarns which regularly cross each other.

The thereby obtained spacer is particularly resistant to compressive forces tending to press the front face onto the rear face. Subject to such forces, the spacer does neither collapse nor lie down thereby retaining its three-dimensional structure to the knit.

The obtained knit has the following properties:

1°) Thickness: 1.7 mm

By its structure, the knit of the present example substantially retains its height even when it is subject to a compressive force tending to press its front face onto the rear face.

2°) Transparence and size of the pores for both front and rear faces:

-   -   small pores (width×height): 2.0×2.4 mm     -   large pores (width×height): 2.1×2.5 mm

By the structure of the knit of the present example, the pores of the front face remain facing the pores of the rear face, even when the knit is subject to a compressive force tending to compress its front face onto its rear face.

FIG. 3 is a view taken with a scanning electron microscope of one face of the knit of the present example. As this is apparent from this view, the pores of the front face are distinctly seen (the closest to the apparatus taking the photograph) and it is also possible to distinguish in the background the pores of the rear face: the pores of the front face and those of the rear face are facing each other. Thus, the knit has excellent transparence which allows the surgeon to handle a prosthesis comprising such a knit with facility and to easily position it, in particular with respect to the surrounding organs. Indeed, the knit of the prosthesis allows the surgeon to have good visibility in transparence of the surrounding organs.

3°) Suture strength, as measured according to the NF S94-8012007 standard “Reinforcement implants set into place via a vaginal route for an urge and/or prolapsus urinary incontinence cure for pelvic organs—pre-clinical tests and clinical tests”—§ 5.2.3, 5 samples 50×100 mm, USP 2/0 suture yarn, crosshead speed: 100 mm/min

-   -   in the warp direction: 30±3 N     -   in the weft direction: 46±2 N

The above test is conducted on a tensile testing machine Hounsfield H5KS-SN 0589.

The knit retains its three-dimensional structure even when it is subject to compressive forces tending to press its front face onto its rear face.

This knit is useful for manufacturing reinforcement prosthesis for example for repairing hernias. It is sufficient to cut out the intended shape, for example a rectangular (see FIG. 5 ) or circular shape (see FIG. 4 ), in the knit of the present example in order to obtain a prosthesis which may be used as a wall reinforcement for treating hernia. A prosthesis according to the invention may consist of a knit according to the present example, alone, cut to the intended shape. Alternatively, the prosthesis may further comprise an anti-adhesion coating and/or one or more additional textile layers, as described with reference to FIGS. 4 and 5 .

EXAMPLE 2

A knit suitable for the prosthesis according to the invention is produced with 88 dtex monofilament polyester yarns.

The knit is produced on a two-bed Rachel knitting machine with 4 threaded guide bars, 1 full stitch, 1 empty stitch, according to the following weave, according to the ISO 11676 standard:

BAV:4.3.2.2/1.0.1.1/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1/1.2.3.3/4.5.4.4/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4//

BE1:1.2.3.3/4.5.1.2/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4/4.3.2.2/1.0.4.3/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1//

BAR1:4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0/1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5//

BAR2:1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5/4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0

This weave is illustrated in FIG. 2 , in which the bars BAV, BE1, BAR1, and BAR2, are indicated with for each bar the path of a yarn (indicated in solid line). In this figure, the numbers 1, 2, 3, . . . 15 indicate the rows of the stitches of the front face; the numbers 1′, 2′, 3′, . . . , 14′ indicate the rows of the stitches of the rear face. Also on this figure, a vertical sequence of points illustrates two columns of stitches, both front and rear, facing each other. In FIG. 2 , the columns are indicated as n, n′, (n+1), (n′+1), (n+2), (n′+2), (n+3), (n′+3), (n+4) and (n′+4).

In the present example, the yarns of the BAV and BE1 bars form the front face, the yarns of the BAR1 and BAR2 bars form the rear face. In the present example, the connecting yarns are therefore yarns from a lap of the front face, i.e. the lap obtained with the BE1 bar. Thus, in the present example, there are no laps of connecting yarns dedicated to the formation of the spacer.

The weave followed for the front face produces a front face comprising pores. Also, the weave followed for the rear face produces a face comprising pores. The pores of the front face are substantially facing the pores of the rear face.

As this appears in FIG. 2 , the yarn forming the spacer is the yarn of the BE1 bar which, at row no 2 and at column (n+4), connects the front face to row no 2′ of the rear face and to the column (n′+1) (see the arrow in the figure). By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by three columns and x′, as defined in the present application, is equal to 3. This yarn then connects row 2′, column (n′+1) of the rear face to row 3, column (n+3) of the front face. By doing this it rejoins the rear face to the front face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by two columns and x, as defined in the present application, is equal to 2.

Next this yarn connects the 8^(th) row and column n of the front face to row 8′, column (n′+3) of the rear face (see the arrow in the figure). By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces and x is equal to 3. Next, the yarn connects row 8′, column (n′+3) of the rear face to row 9, column (n+1) of the front face and here, x′ is equal to 2.

Thus, the obtained spacer is formed with connecting yarns which regularly cross each other thereby generating an optimum entanglement of yarns not parallel with each other.

The thereby obtained spacer is particularly resistant to compressive forces tending to press the front face onto the rear face. Subject to such forces, the spacer neither collapses nor lies down parallel to the front and rear faces, thereby retaining its three-dimensional knitted structure.

This knit is useful for manufacturing reinforcement prosthesis for example for repairing hernias. It is sufficient to cut out the intended shape, for example a rectangular (see FIG. 4 ) or circular shape (see FIG. 5 ), in the knit of the present example in order to obtain a prosthesis which may be used as a wall reinforcement for treating a hernia. A prosthesis according to the invention may consist of a knit according to the present example, alone, cut out to the intended shape. Alternatively, the prosthesis may further comprise an anti-adhesion coating and/or one or more additional textile layers, as described with reference to FIGS. 4 and 5 .

EXAMPLE 3

A knit suitable for the prosthesis according to the invention is produced with 88 dtex monofilament polyester yarns.

The knit is produced on a two-bed Rachel knitting machine with 4 threaded guide bars, 1 full stitch, 1 empty stitch, according to the following weave, according to the ISO 11676 standard:

BAV:4.3.2.2/1.0.1.1/1.2.1.1/1.0.1.1/1.2.1.1/1.0.1.1/1.2.3.3/4.5.4.4/4.3.4.4/4.5.4.4/4.3.4.4/4.5.4.4//

BE1:1.2.3.3/4.5.2.1/4.3.4.5/4.5.4.4/4.3.4.5/4.5.4.4/4.3.2.2/1.0.3.4/1.2.1.0/1.0.1.1/1.2.1.0/1.0.1.1//

BAR1:4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0/1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5//

BAR2:1.1.1.2/3.3.4.5/4.4.4.3/4.4.4.5/4.4.4.3/4.4.4.5/4.4.4.3/2.2.1.0/1.1.1.2/1.1.1.0/1.1.1.2/1.1.1.0

This weave is illustrated in FIG. 6 , in which the bars BAV, BE1, BAR1, and BAR2, are indicated with for each bar the path of a yarn (indicated in solid line). In this figure, the numbers 1, 2, 3, . . . 15 indicate the rows of the stitches of the front face; the numbers 1′, 2′, 3′, . . . , 14′ indicate the rows of the stitches of the rear face. Also on this figure, a vertical sequence of points illustrates two columns of stitches, both front and rear, facing each other. In FIG. 6 , the columns are indicated as n, n′, (n+1), (n′+1), (n+2), (n′+2), (n+3), (n′+3), (n+4) and (n′+4).

In the present example, the yarns of the BAV and BE1 bars form the front face, the yarns of the BAR1 and BAR2 bars form the rear face. In the present example, the connecting yarns are therefore yarns from a lap of the front face, i.e. the lap obtained with the BE1 bar. Thus, in the present example, there are no laps of connecting yarns dedicated to the formation of the spacer.

The weave followed for the front face produces a front face comprising pores. Also, the weave followed for the rear face produces a face comprising pores. The pores of the front face are substantially facing the pores of the rear face.

As this appears in FIG. 6 , the yarn forming the spacer is the yarn of the BE1 bar which, at row no 2 and at column (n+4), connects the front face to row no 2′ of the rear face and to the column (n′+1). By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by three columns and x′, as defined in the present application, is equal to 3. This yarn then connects row 2′, column (n′+1) of the rear face to row 3, column (n+3) of the front face. By doing this it rejoins the rear face to the front face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by two columns and x, as defined in the present application, is equal to 2.

This yarn also connects the 8^(th) row and column n of the front face to row 8′, column (n′+3) of the rear face. By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces and x is equal to 3. Next, the yarn connects row 8′, column (n′+3) of the rear face to row 9, column (n+1) of the front face and here, x′ is equal to 2.

Thus, the obtained spacer comprises connecting yarns which regularly cross each other thereby generating an optimum entanglement of yarns not parallel with each other.

In addition, in the present example, the yarn of the BE1 bar forms additional connections between the front face and the rear face, in which the connecting yarns do not cross each other: these additional connections may be seen on FIG. 6 at rows 3, 5, 9 and 11.

Indeed, at row no 3 and at column (n+3), the yarn connects the front face to row no 3′ of the rear face and to the column (n′+4). By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by one column. This yarn then connects row 3′, column (n′+4) of the rear face to row 4, column (n+4) of the front face. By doing this it rejoins the rear face to the front face perpendicularly to these faces, with no shift of column. The same phenomenon is repeated starting at row 5.

In addition, at row no 9 and at column (n+1), the yarn connects the front face to row no 9′ of the rear face and to the column n′. By doing this, it rejoins the front face to the rear face obliquely and not perpendicularly to these faces: in this example, the yarn is shifted by one column. This yarn then connects row 9′, column n′ of the rear face to row 10, column n of the front face. By doing this it rejoins the rear face to the front face perpendicularly to these faces, with no shift of column. The same phenomenon is repeated starting at row 11.

Such additional connections between the front and the rear face, with connecting yarns which are yarns from a lap of the front face, bring additional resistance to compressive force to the knitted structure.

The thereby obtained spacer is particularly resistant to compressive forces tending to press the front face onto the rear face. Subject to such forces, the spacer neither collapses nor lies down parallel to the front and rear faces, thereby retaining its three-dimensional knitted structure.

The obtained knit has the following properties:

1°) Thickness: 1.3 mm

By its structure, the knit of the present example substantially retains its height even when it is subject to a compressive force tending to press its front face onto the rear face.

2°) Transparence and size of the pores for both front and rear faces:

-   -   pores (width×height): 2.0×3.3 mm

By the structure of the knit of the present example, the pores of the front face remain facing the pores of the rear face, even when the knit is subject to a compressive force tending to compress its front face onto its rear face.

FIG. 7 is a view taken with a scanning electron microscope of one face of the knit of the present example. As this is apparent from this view, the pores of the front face and of the rear face are aligned on each other so that it is possible to clearly see the background behind the knit through the knit: the pores of the front face and those of the rear face are facing each other. Thus, the knit has excellent transparence which allows the surgeon to handle a prosthesis comprising such a knit with facility and to easily position it, in particular with respect to the surrounding organs. Indeed, the knit of the prosthesis allows the surgeon to have good visibility in transparence of the surrounding organs.

3°) Suture strength, as measured according to the NF S94-8012007 standard “Reinforcement implants set into place via a vaginal route for an urge and/or prolapsus urinary incontinence cure for pelvic organs—pre-clinical tests and clinical tests”—§ 5.2.3, 5 samples 50×100 mm, USP 2/0 suture yarn, crosshead speed: 100 mm/min

-   -   in the warp direction: 46±3 N     -   in the weft direction: 50±6 N

The above test is conducted on a tensile testing machine Hounsfield H5KS-SN 0589.

The knit retains its three-dimensional structure even when it is subject to compressive forces tending to press its front face onto its rear face.

This knit is useful for manufacturing reinforcement prosthesis for example for repairing hernias. It is sufficient to cut out the intended shape, for example a rectangular (see FIG. 4 ) or circular shape (see FIG. 5 ), in the knit of the present example in order to obtain a prosthesis which may be used as a wall reinforcement for treating a hernia. A prosthesis according to the invention may consist of a knit according to the present example, alone, cut out to the intended shape. Alternatively, the prosthesis may further comprise an anti-adhesion coating and/or one or more additional textile layers, as described with reference to FIGS. 4 and 5 . 

The invention claimed is:
 1. A method of treating a hernia defect comprising: introducing at least one openworked three-dimensional knit into a body of a patient, the at least one openworked three-dimensional knit including two opposite faces, a first face and a second face, each first and second face being formed with one or several laps of yarns defining pores on said first and second faces, said pores of the first face and the pores of the second face being substantially aligned on each other providing the knit with transparence, said first face being bound to said second face by connecting yarns defining a spacer, wherein the connecting yarns are distributed so that said connecting yarns define a crisscrossing set of yarns crossing each other at the spacer, without obstructing the pores of the two opposite faces, wherein the pores of the first face and the pores of the second face remain in the same relative position when the knit is subject to compressive forces thereby maintaining the transparence of the knit, and placing the at least one openworked three-dimensional knit at the hernial defect with the first face facing the abdominal cavity and the second face facing the abdominal wall.
 2. The method of claim 1, wherein the connecting yarns are yarns from at least one lap from the laps forming the opposite faces.
 3. The method of claim 1, wherein the connecting yarns are yarns from one or more laps dedicated to the formation of the spacer.
 4. The method of claim 1, wherein the spacer has an X-profile.
 5. The method of claim 1, wherein the first face includes r rows and n columns of stitches facing r′ rows and n′ columns of stitches of the second face, with at least one portion of the connecting yarns connecting a column n_(i) of the n columns of stitches of the first face to a column (n_(i)′+x) of n′ columns of stitches of the second face, wherein x ranges from 2 to 5, and connecting a column n_(j) of the n columns of stitches of the first face to a column (n_(j)′−x′) of n′ columns of stitches of the second face, wherein x′ ranges from 2 to
 5. 6. The method of claim 5, wherein x=x′.
 7. The method of claim 5, wherein x=x′=2.
 8. The method of claim 5, wherein x is different from x′.
 9. The method of claim 1, wherein the second face includes an additional textile layer attached thereto.
 10. The method of claim 9, further comprising attaching the additional textile layer directly to the abdominal wall to promote cell colonization into the second face of the knit.
 11. The method of claim 10, wherein the additional textile layer is a skirt including a central aperture.
 12. The method of claim 1, wherein the first face includes an anti-adhesion coating thereon.
 13. The method of claim 12, wherein the anti-adhesion coating is bioresorbable.
 14. The method of claim 13, wherein the anti-adhesion coating is in the form of a bioresorbable textile.
 15. The method of claim 14, wherein the bioresorbable textile includes oxidized cellulose.
 16. The method of claim 13, wherein the anti-adhesion coating is in the form of a bioresorbable film.
 17. The method of claim 13, wherein the anti-adhesion coating is a film includes one or more of collagen, glycerol or chitosan.
 18. The method of claim 9, wherein the openworked three-dimensional knit is in the form of a continuous part having a periphery, the additional textile layer being provided with a central aperture, and the first face covered with an anti-adhesion coating.
 19. A method of treating a hernia defect comprising: introducing at least one openworked three-dimensional knit into a body of a patient, the at least one openworked three-dimensional knit including two opposite faces, a first face and a second face, each first and second face being formed with one or several laps of yarns defining pores on said first and second faces, said first face being bound to said second face by connecting yarns defining a spacer, wherein the connecting yarns are distributed so that said connecting yarns define a crisscrossing set of yarns crossing each other at the spacer, without obstructing the pores of the two opposite faces, said second face including an additional textile layer attached thereto, placing the at least one openworked three-dimensional knit at the hernial defect with the first face facing the abdominal cavity and the second face facing the abdominal wall, and attaching the additional textile layer directly to the abdominal wall to promote cell colonization into the second face of the knit.
 20. The method of claim 19, wherein the additional textile layer is a skirt including a central aperture.
 21. The method of claim 19, wherein the first face includes an anti-adhesion coating thereon. 